Spine Journal最新文献

{"title":"Disparity in resource utilization of motion-sparing anterior cervical spine surgery: an analysis of NSQIP® and PearlDiver® database.","authors":"Muhammad Umar Jawad, Haroon M Kisana, Victoria N Greenstein, Donnell B McDonald, Norman B Chutkan","doi":"10.1016/j.spinee.2025.01.017","DOIUrl":"10.1016/j.spinee.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>Widespread racial, gender-related, socioeconomic and insurance-related disparities have been widely implicated in the utilization of new and improved surgical techniques including various aspects spinal surgery. A comprehensive analysis of such disparities is lacking for motion-preserving techniques in cervical spine surgery.</p><p><strong>Purpose: </strong>To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery.</p><p><strong>Study design/ setting: </strong>Retrospective review of large database PATIENT SAMPLE: NSQIP® database from 2010 to 2021 and PearlDiver® database from 2010 to 2022 were queried. CPT codes for cervical disc arthroplasty (CDA), and anterior cervical discectomy and fusion (ACDF) were utilized to isolate the case records (Table 1 and 3).</p><p><strong>Outcome measures: </strong>Preoperative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment.</p><p><strong>Methods: </strong>Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively.</p><p><strong>Results: </strong>A total of 5,912 and 32,625 CDA cases and 69,701 and 526,851 ACDF cases were isolated from NSQIP® and PearlDiver®, respectively. 'Younger' age, 'Asian Pacific Islander' race and elective surgery (p<.001), were associated with undergoing CDA in NSQIP® database. Presence of Type 1 diabetes, smoking and hypertension (HTN) (p<.001) were associated with undergoing ACDF in NSQIP®. PearlDiver® database showed 'Younger' age, higher area-level 'Family Income', and a higher mean percent of patients with 'private health insurance' (p<.001) were associated with undergoing CDA. Higher area level unemployment was associated with ACDF.</p><p><strong>Conclusion: </strong>Wide spread racial, gender-related, and socioeconomic disparities have been observed. Identification of these disparities is sentinel for implication of change in health-care policy mitigating issues such as underinsurance leading to establishment of health equity.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network","authors":"William Chu Kwan MD, PhD, FRCSC ,&nbsp;Tamir Ailon MD, MPH, FRCSC ,&nbsp;Nicolas Dea MD, MSc, FRCSC ,&nbsp;Nathan Evaniew MD, Msc, FRCSC ,&nbsp;Raja Rampersaud MD, FRCSC ,&nbsp;W. Bradley Jacobs MD, FRCSC ,&nbsp;Jérome Paquet MD, FRCSC ,&nbsp;Jefferson R. Wilson MD, PhD, FRCSC ,&nbsp;Hamilton Hall MD, FRCSC ,&nbsp;Christopher S. Bailey MD, FRCSC ,&nbsp;Michael H. Weber MD, PhD, FRCSC ,&nbsp;Andrew Nataraj MD, MSc, FRCSC ,&nbsp;David W. Cadotte MD, PhD, FRCSC ,&nbsp;Philippe Phan MD, MSc, FRCSC ,&nbsp;Sean D. Christie MD, FRCSC ,&nbsp;Charles G. Fisher MD, MHSC, FRCSC ,&nbsp;Supriya Singh MD, FRCSC ,&nbsp;Neil Manson MD, FRCSC ,&nbsp;Kenneth C. Thomas MD, FRCSC ,&nbsp;Jay Toor MD, FRCSC ,&nbsp;Raphaële Charest-Morin MD, FRCSC","doi":"10.1016/j.spinee.2024.09.024","DOIUrl":"10.1016/j.spinee.2024.09.024","url":null,"abstract":"<div><h3>Background Context</h3><div>Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.</div></div><div><h3>Purpose</h3><div>Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.</div></div><div><h3>Design</h3><div>This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN).</div></div><div><h3>Patient Sample</h3><div>Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021.</div></div><div><h3>Outcome Measures</h3><div>Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale.</div></div><div><h3>Methods</h3><div>Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups.</div></div><div><h3>Results</h3><div>Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, −3%, −10%, −14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI=0.81–0.90). No patient demographic or surgical factors influenced satisfaction.</div></div><div><h3>Conclusions</h3><div>Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 265-275"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision surgery rates following transforaminal lumbar interbody fusion in patients with and without osteoporosis.","authors":"Ashley Knebel, Manjot Singh, Michael J Farias, Brian McCrae, Lauren Fisher, Joseph E Nassar, Bassel G Diebo, Alan H Daniels","doi":"10.1016/j.spinee.2025.01.015","DOIUrl":"10.1016/j.spinee.2025.01.015","url":null,"abstract":"<p><strong>Background context: </strong>Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques.</p><p><strong>Purpose: </strong>To compare complications and radiographic alignment in osteoporotic versus nonosteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study.</p><p><strong>Outcome measures: </strong>The following data were observed for all cases: patient demographics, radiographic alignment, and complications.</p><p><strong>Methods: </strong>Adult patients with 2-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to 2-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF.</p><p><strong>Results: </strong>In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At 2 years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from preoperation (6.55° vs. -0.02°, p=.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment disease (p=.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=.008) than patients without osteoporosis, most commonly for adjacent segment disease.</p><p><strong>Conclusion: </strong>In this single-center multisurgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proteome analysis reveals paraspinal muscle fiber type changes in patients with degenerative lumbar scoliosis.","authors":"Abdukahar Kiram, Jie Li, Qiang Liu, Chen Ling, Hui Xu, Changsheng Fan, Zongshan Hu, Zezhang Zhu, Yong Qiu, Zhen Liu","doi":"10.1016/j.spinee.2025.01.026","DOIUrl":"10.1016/j.spinee.2025.01.026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative lumbar scoliosis (DLS) is a common aging-related spinal deformity. Paraspinal muscle degeneration is highly correlated with the rapid progression of DLS. However, understanding of the role of the praspinal muscle degeneration is limited because of a lack of histologic and molecular evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Our study profiled the proteomic alteration of paraspinal muscles and investigated the muscle fiber type transition that occurs in DLS, along with its correlation with clinical parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional basic science study using clinical data and biological samples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Paraspinal muscle samples were collected intraoperatively from the concave and convex sides of the apex vertrebrae in patients with DLS (n=10) and either side of L3 level from age- and sex-matched participants without DLS (n=10). Analysis was perfomed using isobaric tagging for relative and absolute quantitation (iTRAQ) and liquid chromatography with tandem mass spectrometry on muscle tissue from the convex side of spines in patients with DLS and in participants without DLS to identify differentially expressed proteins (DEPs). Western blotting was used to validate the DEPs. The measurement of acidity/basicity of ATPase (pH=9.4), succinic acid dehydrogenase staining, and real-time quantitative polymerase chain reaction were performed to assess the muscle fiber type change in DLS. The Pearson correlation coefficient was used to analyze the correlation between the myofiber transition and the Cobb angle of the main curve. This study was supported by the National Natural Science Foundation of China (NSFC) (No. 82272545), $ 8,000-10,000 and the Jiangsu Provincial Key Medical Center, and the China Postdoctoral Science Foundation (2021M701677, $ 5,000-7,000).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 62 DEPs, of which 16 were downregulated and 46 were upregulated. Gene ontology indicated significant changes in biological processes including muscle contraction. Protein-protein interaction network analysis showed that structural muscle proteins such as MYH1 (myosin heavy chain 1) and TNNT3 (troponin T) were the key nodes. Western blotting further validated the downregulation of MYH1 in the paraspinal muscle of DLS. Histologically, ATPase staining showed a significant reduction of type II muscle fibers in DLS, consistent with the functional changes of the DEPs. Furthermore, we found that the reduction of type II muscle fibers percentage was correlated with the severity of DLS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study is the first to elucidate the underlying molecular basis and pathways that implicate the paraspinal muscle fiber type transition in DLS. Type II myofiber percentage was diminished both on the concave side and the convex side of the paraspinal muscles in DLS, especially on the convex side, which may play an important role in the onse","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timeline of curve progression around menarche in small adolescent idiopathic scoliosis curves without influence of braces: a single-center longitudinal cohort study of 1,090 patients.","authors":"Yosuke Ogata, Toshiaki Kotani, Tomoyuki Asada, Shuhei Ohyama, Shun Okuwaki, Yasushi Iijima, Tsuyoshi Sakuma, Seiji Ohtori, Masashi Yamazaki","doi":"10.1016/j.spinee.2025.01.022","DOIUrl":"10.1016/j.spinee.2025.01.022","url":null,"abstract":"<p><strong>Background context: </strong>Menarche is widely recognized as one of the prognostic factors for curve progression in patients with adolescent idiopathic scoliosis (AIS). However, few studies focus on the relationship between small AIS curves without brace treatment and menarche, presenting a challenge to building further evidence.</p><p><strong>Purpose: </strong>This study aims to investigate the chronological changes in curve progression and risk of final brace initiation around menarche in small AIS curves under 25°.</p><p><strong>Study design: </strong>This was a retrospective cohort study.</p><p><strong>Patient sample: </strong>We longitudinally examined 1,090 AIS patients with a curve of less than 25° at the initial visit.</p><p><strong>Outcome measures: </strong>Patients were followed up until they achieved skeletal maturity or initiated brace treatment.</p><p><strong>Methods: </strong>Curve progression based on time from menarche was analyzed using a t-test. Receiver operating characteristic curve analysis was performed based on the time from menarche, with curve magnitude as the independent variable and the final initiation of brace treatment as the dependent variable.</p><p><strong>Results: </strong>Overall, 1,090 female patients were included, with a mean initial visit age of 12.9 years (standard deviation [SD]: 1.5) and a mean coronal Cobb angle of 17.5° (SD: 4.3). Curve progression was significantly decreased between 0-1 and 1-2 years post-menarche (0-1 year post-menarche: 2.9°/year vs. 1-2 years post-menarche: 1.3°/year; p=.03). After 2 years from menarche, the mean curve progression was less than 0.4°/year. The cut-off value of the curve magnitude for the final initiation of brace treatment at the timing of menarche was 20.5° (area under the curve: 0.89, p<.001, 95% confidence interval: 0.86-0.91).</p><p><strong>Conclusions: </strong>This study highlights that in small AIS curves under 25°, minimal curve progression was observed after 2 years post-menarche, aiding follow-up strategies for AIS conservative treatment.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of twelve existing survival prediction models for patients with spinal metastases.","authors":"B J J Bindels, R H Kuijten, O Q Groot, E H Huele, R Gal, M C H de Groot, J M van der Velden, D Delawi, J H Schwab, H M Verkooijen, J J Verlaan, D Tobert, J P H J Rutges","doi":"10.1016/j.spinee.2025.01.014","DOIUrl":"10.1016/j.spinee.2025.01.014","url":null,"abstract":"<p><strong>Background context: </strong>Survival prediction models for patients with spinal metastases may inform patients and clinicians in shared decision-making.</p><p><strong>Purpose: </strong>To externally validate all existing survival prediction models for patients with spinal metastases.</p><p><strong>Design: </strong>Prospective cohort study using retrospective data.</p><p><strong>Patient sample: </strong>953 patients.</p><p><strong>Outcome measures: </strong>Survival in months, area under the curve (AUC), and calibration intercept and slope.</p><p><strong>Method: </strong>This study included patients with spinal metastases referred to a single tertiary referral center between 2016 and 2021. Twelve models for predicting 3, 6, and 12-month survival were externally validated Bollen, Mizumoto, Modified Bauer, New England Spinal Metastasis Score, Original Bauer, Oswestry Spinal Risk Index (OSRI), PathFx, Revised Katagiri, Revised Tokuhashi, Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA), Tomita, and Van der Linden. Discrimination was assessed using (AUC) and calibration using the intercept and slope. Calibration was considered appropriate if calibration measures were close to their ideal values with narrow confidence intervals.</p><p><strong>Results: </strong>In total, 953 patients were included. Survival was 76.4% at 3 months (728/953), 62.2% at 6 months (593/953), and 50.3% at 12 months (479/953). Revised Katagiri yielded AUCs of 0.79 (95% CI, 0.76-0.82) to 0.81 (95% CI, 0.79-0.84), Bollen yielded AUCs of 0.76 (95% CI, 0.73-0.80) to 0.77 (95% CI, 0.75-0.80), and OSRI yielded AUCs of 0.75 (95% CI, 0.72-0.78) to 0.77 (95% CI, 0.74-0.79). The other 9 prediction models yielded AUCs ranging from 0.59 (95% CI, 0.55-0.63) to 0.76 (95% CI, 0.74-0.79). None of the twelve models yielded appropriate calibration.</p><p><strong>Conclusions: </strong>Twelve survival prediction models for patients with spinal metastases yielded poor to fair discrimination and poor calibration. Survival prediction models may inform decision-making in patients with spinal metastases, provided that recalibration using recent patient data is performed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: a prospective study.","authors":"Yu-Cheng Yao, Jing-Yang Liou, Hsin-Yi Wang, Po-Hsin Chou, Hsi-Hsien Lin, Shi-Tien Wang","doi":"10.1016/j.spinee.2025.01.023","DOIUrl":"10.1016/j.spinee.2025.01.023","url":null,"abstract":"<p><strong>Background context: </strong>Enhanced Recovery After Surgery (ERAS) protocols have been shown to accelerate patient recovery across various surgical fields. There are growing reports of the benefits of ERAS for lumbar fusion, but the majority rely on retrospective analysis.</p><p><strong>Purpose: </strong>This study aimed to prospectively assess the impact of an ERAS protocol on perioperative outcomes in patients undergoing lumbar spinal fusion.</p><p><strong>Study design/setting: </strong>Prospective comparative cohort study conducted at a tertiary medical center in Taipei, Taiwan, between November 2020 and May 2023.</p><p><strong>Patient sample: </strong>The study included 242 patients undergoing lumbar spinal fusion for degenerative spinal conditions divided into ERAS and non-ERAS groups.</p><p><strong>Outcome measures: </strong>Main outcomes measured included operative duration, estimated blood loss (EBL), postoperative nausea and vomiting (PONV), analgesic use, and visual analog scale (VAS) pain score.</p><p><strong>Methods: </strong>Propensity score matching (PSM) was used to minimize confounders between the 2 groups. Differences between the 2 groups were assessed using the 2-sample independent t-test or nonparametric Mann-Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>The ERAS group had significantly shorter operative time (202±68 min vs. 255±85 min) and EBL (480±302 ml vs. 641±387 ml) compared to the non-ERAS group. The ERAS group had significantly less total morphine-sulfate-equivalent (MSE) consumption (27±24 mg vs. 42±42 mg) and used patient-controlled analgesia (PCA) (97% vs. 41%) more frequently compared to the non-ERAS group. Notably, the ERAS group had a shorter time to ambulation and shorter time to removal of Foley catheters.</p><p><strong>Conclusions: </strong>These data suggest that the employed ERAS protocol significantly enhances recovery trajectories and the need for analgesics in patients undergoing lumbar spinal fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning model and a web application for predicting neurological outcome at hospital discharge in spinal cord injury patients.","authors":"Kyota Kitagawa, Satoshi Maki, Takeo Furuya, Yuki Shiratani, Yuki Nagashima, Juntaro Maruyama, Yasunori Toki, Shuhei Iwata, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori","doi":"10.1016/j.spinee.2025.01.005","DOIUrl":"10.1016/j.spinee.2025.01.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spinal cord injury (SCI) is a devastating condition with profound physical, psychological, and socioeconomic consequences. Despite advances in SCI treatment, accurately predicting functional recovery remains a significant challenge. Conventional prognostic methods often fall short in capturing the complex interplay of factors influencing SCI outcomes. There is an urgent demand for more precise and comprehensive prognostic tools that can guide clinical decision-making and improve patient care in SCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to develop and validate a machine learning (ML) model for predicting American Spinal Injury Association (ASIA) Impairment Scale (AIS) at discharge in SCI patients. We also aim to convert this model into an open-access web application.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This was a retrospective cohort study enrolling traumatic SCI patients from 1991 to 2015, analyzed in 2023. Data were obtained from the Japan Rehabilitation Database (JARD), a comprehensive nationwide database that includes SCI patients from specialized SCI centers and rehabilitation hospitals across Japan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients sample: &lt;/strong&gt;4,108 SCI cases from JARD were reviewed, excluding 405 cases, patients caused by nontraumatic injuries, patients who were graded as AIS E at admission, and patients without data of AIS at discharge, resulting in 3,703 cases being included in the study. Patient demographics and specific SCI injury characteristics at admission were utilized for model training and prediction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Model performance was evaluated based on R&lt;sup&gt;2&lt;/sup&gt;, accuracy, and the weighted Kappa coefficient. Shapley additive explanations (SHAP) values highlighted significant features influencing the model's output.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The primary outcome was AIS at discharge, treated as a continuous variable (0-4) to capture the ordinal nature and clinical significance of potential misclassifications. Data preprocessing included multicollinearity removal, feature selection using the Boruta algorithm, and iterative imputation for missing data. The dataset was split using the hold-out method with a 7:3 ratio resulting in 2,592 cases for training and 1,111 cases for testing the regression model. A best performing model was defined as the highest R&lt;sup&gt;2&lt;/sup&gt; using PyCaret's automated model comparison. Final predictions of regression model were discretized to the original AIS categories for clinical interpretation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Gradient Boosting Regressor (GBR) was identified as the optimal model. The GBR model showed an R² of 0.869, accuracy of 0.814, and weighted Kappa of 0.940. Eleven key variables, including AIS at admission, the day from injury to admission, and the motor score of L3, were identified as significant based on SHAP values. This model was then adapted into a web application via Streamlit.&lt;/p&gt;&lt;p&gt;&lt;strong","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk prediction model of pedicle screw loosening within 2 years after decompression and instrumented fusion surgery for degenerative lumbar disease.","authors":"Yen-Chun Huang, Po-Chun Liu, Hsi-Hsien Lin, Shih-Tien Wang, Yu-Ping Su, Po-Hsin Chou, Yu-Cheng Yao","doi":"10.1016/j.spinee.2025.01.033","DOIUrl":"10.1016/j.spinee.2025.01.033","url":null,"abstract":"<p><strong>Background context: </strong>Pedicle screw loosening (PSL) after spinal fusion surgery is one of the most frequently reported complications and leads to poor clinical outcomes.</p><p><strong>Purpose: </strong>This study aimed to develop and validate a risk prediction model for PSL within 2 years in patients undergoing lumbar instrumented fusion surgery based on their risk profiles.</p><p><strong>Study design/setting: </strong>Retrospective, observational study.</p><p><strong>Patient sample: </strong>Patients who underwent lumbar instrumented fusion surgery at a single academic institution between May 2015 and February 2019.</p><p><strong>Outcome measures: </strong>Risk assessment of PSL and development of a rating score based on patient characteristics.</p><p><strong>Methods: </strong>The demographic profiles and radiographic parameters using computed tomography were obtained. These factors were analyzed to determine possible risk factors related to postoperative PSL after 2 years. A scoring system was developed using these independent risk factors and validated using prospectively collected data from another center between May 2019 and December 2021.</p><p><strong>Results: </strong>The occurrence of PSL within 2 years postoperation was 12.7% (40/315). PSL was significantly predicted by smoking, low Hounsfield units (HU) of the pedicle tract at the index level (P), and a low psoas-lumbar vertebral index (PLVI). The risk of PSL according to the categories of the risk score was 1.1% for those with a score of 0-1, 15.1% for a score of 2-3, and 61.5% for a score of 4-6. In validation, this model demonstrated both good discrimination and calibration results. The area under the curve was 0.887 (95% CI 0.830-0.938) for the derivation cohort and 0.835 (95% CI 0.738-0.918) for the external validation cohort.</p><p><strong>Conclusions: </strong>This PSL risk score, including smoking, Index P HU, and PLVI, is a novel approach to predict PSL 2 years postsurgery. This approach highlights the role of factors associated with osteoporosis and sarcopenia in the development of PSL and could aid in preoperative decision-making and surgical planning.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the best strategy for C3 in open-door laminoplasty: laminectomy versus laminoplasty-a systematic review and meta-analysis.","authors":"Chun-Ru Lin, Sung Huang Laurent Tsai, Po-An Tsai, Yi-Jun Chen, Ming-Hao Chen, Sz-An Tsai, Lin-Sheng Hsu, Kuo-Hao Lee, Zhi Yi Lee, Fu-Cheng Kao, Ming-Kai Hsieh, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu, Chi-Chien Niu, Ping-Yeh Chiu","doi":"10.1016/j.spinee.2025.01.034","DOIUrl":"10.1016/j.spinee.2025.01.034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional open-door laminoplasty is commonly used to treat multilevel cervical disorders but often leads to complications such as loss of cervical lordosis, limited neck motion, and axial symptoms. These issues stem from the extensive disruption of musculature and structural alterations involved in conventional methods. To address these shortcomings, the modified open-door laminoplasty with C3 laminectomy technique has been developed as a modification of conventional open-door laminoplasty, with the aims to preserve the semispinalis cervicis muscle attached to the C2 spinous process, potentially improving postoperative outcomes by maintaining muscle integrity and stability of the cervical spine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study seeks to evaluate the clinical benefits of modified open-door laminoplasty with C3 laminectomy in comparison to conventional open-door laminoplasty approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Patient Sample: patients undergoing open-door laminoplasty OUTCOME MEASURES: The outcome measures assessed were categoried into self-report Measure including pain indices, physiologic measures including complications, and functional measures including operative time, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, length of hospital stay, and cervical range of motion (ROM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Library, to identify randomized controlled trials (RCTs), cohort studies, and case-control studies that compare the clinical outcomes of conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy. Statistical analyses were performed using RevMan software to evaluate the differences between the 2 surgical techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis included 11 studies encompassing 873 participants. The meta-analysis revealed no significant differences between patients undergoing conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy regarding operation time (mean difference, MD: 5.08, 95% confidence interval, CI: -3.04 to 13.21), length of hospital stay (MD: -0.33, 95% CI: -1.43 to 0.77), JOA scores (MD: 0.18, 95% CI: -0.03 to 0.40), NDI scores (MD: -0.14, 95% CI: -4.00 to 3.72), and complication rates (risk difference, RD: 0.01, 95% CI: -0.03 to 0.04). However, participants in the group that underwent modified open-door laminoplasty with C3 laminectomy exhibited a significantly greater range of motion (MD: 4.13, 95% CI: 0.07 to 7.20) and lower postoperative pain scores (standard mean difference, SMD: -0.57, 95% CI: -1.05 to -0.10).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study suggests that modified open-door laminoplasty with C3 laminectomy improves range of motion and reduces pain compared to conventional open-door laminoplasty, with no di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}